Violence In Psychiatric Hospitals Research Articles

Dual harm: Violent behaviour to others and self-harm behaviour in adults compulsorily admitted to a Dutch psychiatric hospital

BackgroundVerbal and physical violence in psychiatric hospitals can have harmful consequences for staff members, such as physical injury, traumatisation, and sick leave, and they often accompany involuntary admission. Harm to others may co-occur with self-harm, i.e., dual harm. However, little is known about the association between dual-harm and violent behaviour towards staff members and its clinical outcomes, such as seclusion and rapid tranquilisation after involuntary admission to a psychiatric inpatient unit. MethodA convenience sample of patients admitted involuntarily (N = 384; mean age = 48.03, SD = 19.92) between January 2016 and December 2019 in Western Brabant, the Netherlands, was used to design a retrospective file audit. Distinct harm groups, marked by the presence/absence of self- and/or other-harm, were investigated using multivariate linear regression modelling on the seriousness of violent acts and the total length of admission. Logistic regression analyses were used to study the association between harm groups and the administration of rapid tranquilisation, seclusion, and extended involuntary admissions. ResultsSeveral harm groups were identified, including self-harm only, other-harm only, and dual-harm groups. Psychiatric patients admitted to the hospital because of (the risk of) violence towards others had a higher risk of violent incidents during admission and some restrictive measures. In a subgroup of patients with psychotic disorders, patients with dual harm committed the most serious violent incidents compared to those in the other harm groups. ConclusionDistinct harm groups were identified in a sample of involuntarily admitted patients. In a general adult psychiatric setting, patients at risk for violent behaviour, especially dual-harm patients, should be identified and monitored as part of the risk assessment. Future research is needed to explore more clinical correlates in the proposed distinction between harmful groups and to assess long-term prognosis.

Thematic Analysis of Mental Health Nurses' Views of Contributing Factors Fueling Workplace Violence in Psychiatric Hospitals: Insights From Unsung Soldiers.

Workplace violence against mental health nurses is an international phenomenon that sparks concerns for nurses' safety and mental health. This phenomenon has recently arisen as a crucial concern in the Middle East as it has become pervasive and has negative implications, causing nurses to accumulate psychological and emotional distress. However, no research has yet investigated the contributing factors of this phenomenon in Jordanian psychiatric hospitals from the nurses' perspectives. This study aimed to explore the factors contributing to workplace violence in Jordanian psychiatric hospitals from the perspective of mental health nurses. An exploratory, qualitative design was utilized. Using audio-recorded, semi-structured, face-to-face interviews, a purposive sample of 24 mental health nurses were interviewed to collect data. Thematic analysis was used to analyze the data. Four overarching themes were identified: Peak Time of Violence, Unavoidable Part of the Job, Poor Organization and Lack of Policy, and Bite the Bullet. From nurses' perspectives, an in-depth understanding of factors contributing to workplace violence provides a foundation for developing preventive interventions, improving work environment safety, and promoting nurses' mental health. Prevention strategies and further studies are warranted to limit this phenomenon.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study.

We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health. Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma. We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms. We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support. Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being. Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study

Aggressive behavior and violence in psychiatric patients have often been quoted to justify more restrictive settings in psychiatric facilities. However, the effects of open vs. locked door policies on aggressive incidents remain unclear. This study had a naturalistic observational design and analyzed the occurrence of aggressive behavior as well as the use of seclusion or restraint in 21 German hospitals. The analysis included data from 1998 to 2012 and contained a total of n = 314,330 cases, either treated in one of 17 hospitals with (n = 68,135) or in one of 4 hospitals without an open door policy (n = 246,195). We also analyzed the data according to participants' stay on open, partially open, or locked wards. To compare hospital and ward types, we used generalized linear mixed-effects models on a propensity score matched subset (n = 126,268) and on the total dataset. The effect of open vs. locked door policy was non-significant in all analyses of aggressive behavior during treatment. Restraint or seclusion during treatment was less likely in hospitals with an open door policy. On open wards, any aggressive behavior and restraint or seclusion were less likely, whereas bodily harm was more likely than on closed wards. Hospitals with open door policies did not differ from hospitals with locked wards regarding different forms of aggression. Other restrictive interventions used to control aggression were significantly reduced in open settings. Open wards seem to have a positive effect on reducing aggression. Future research should focus on mental health care policies targeted at empowering treatment approaches, respecting the patient's autonomy and promoting reductions of institutional coercion.

Mania, homicide and severe violence

Mania has been reported to be a risk factor for aggression and violence in psychiatric hospitals, but the extent of any association between mania and severe interpersonal violence in community settings is not known. To examine the association between mania and severe violence in a series of patients found not guilty by reason of mental illness (NGMI). A review of the court documents of those found NGMI of offences involving severe violence, including homicide, attempted homicide and assault causing wounding or serious injury, in New South Wales between 1992 and 2008. Twelve of 272 people found NGMI were in a manic state when they committed a severe violence offence. Ten were diagnosed with schizo-affective disorder and two with bipolar disorder. Three patients were in the depressed phase of schizo-affective disorder and there were no patients in the depressed phase of bipolar disorder. Mania, in particular the manic phase of bipolar disorder, is not strongly associated with severe violence.

A narrative review of the effectiveness of aggression management training programs for psychiatric hospital staff

Workplace violence, including patient-perpetrated violence in healthcare settings, is increasingly being recognized as preventable. Staff training has been identified as a necessary component of any initiative aimed at preventing or reducing incidents of aggression and violence in the workplace. This narrative review of the literature evaluates the effectiveness of staff training programs designed to prevent and manage violence and aggression in psychiatric hospitals. An exhaustive review of the literature was performed on all articles published in English between January 1, 1990 and April 1, 2007 that evaluate an aggression management training program. Twenty-nine studies met the inclusion criteria for a full review and were summarized using a qualitative narrative approach. Aggression management training has been proven effective in some areas, such as reducing the use of restraints and other coercive control devices, but more methodologically rigorous research is needed to firmly establish whether it is effective in reducing aggression and staff injuries. The findings of this study suggest that relying too heavily on aggression management staff training will have limited effect on addressing the range of issues related to patient-perpetrated violence in psychiatric hospitals. Mental healthcare organizations must look beyond staff training if they are to achieve meaningful reductions in aggressive incidents and staff injuries.

A tentative model of aggression on inpatient psychiatric wards.

Violence in psychiatric hospitals threatens the safety and well-being of patients and staff members. The determinants and correlates of inpatient aggression are not well understood. The authors present an explanatory model of aggressive behavior that attempts to integrate patient, staff, and ward variables. In the proposed model, the patient's psychopathology and distorted cognitions are exacerbated by environmental and communication stressors found on psychiatric wards. The model emphasizes that repeated inpatient aggression may be the result of a vicious circle, whereby a patient's violent behavior is often followed by an increase in stress on the patient caused by environmental or communication factors, heightening the risk of another outburst of violence.

Finding ways to reduce violence in psychiatric hospitals.

Managers at Kino Community Hospital in Tucson, AZ, were growing concerned about patient violence and its effects. This worry resulted from an increasing number of injuries to staff caused by patients in addition to the escalating costs of workers' compensation claims. Managers theorized that staff injuries could be decreased by changing staffing patterns, practicing crisis intervention techniques more frequently, and establishing continuing education classes. The hospital therefore implemented a step-by-step violence prevention program for its inpatient psychiatric department, an action that led to markedly fewer staff injuries by the end of 1996. A detailed account of this program follows.

Aversive stimulation by staff and violence by psychiatric patients

This study investigated the frequency with which violence by psychiatric in-patients was preceded by aversive interpersonal stimulation. The precursors of 63 assaults by psychiatric patients on nurses were studied using semi-structured interviews conducted within 72 hours of the assault. Reliability data were collected from staff witnesses and assaultive patients in a subgroup of assaults. Eighty-six per cent of the assaults were immediately preceded by the assaulted nurse having delivered an aversive stimulus to the patient, e.g. frustration, activity demand or physical contact. There were significant associations between diagnosis and the type of aversive stimulation which preceded assaults. Interpersonal factors and diagnosis therefore seem to play a significant role in most violence in psychiatric hospitals and only a minority of patients behave aggressively in the absence of aversive stimulation. An explanation of the link between psychosis and aggressive behaviour in terms of distorted social cognition is discussed.

An observational study of associations between nurse behaviour and violence in psychiatric hospitals.

A cyclical model of violence to psychiatric nurses is proposed in this paper and a partial test of the model is reported. The model suggests that stress induced by exposure to violence leads to impaired staff performance and adoption of behaviours which make the re-occurrence of violence more likely. We tested the proposal that certain staff behaviours (e.g. expressing verbal hostility) are associated with an increased risk of assault by observing nurse-patient interaction on 12 psychiatric wards (n = 103 nurses). The verbal and physical interaction of (1) assaulted staff, (2) staff on violent wards, and (3) staff in grades which experience high levels of assault, were compared with those of respective low risk groups. There was some evidence of an association between interaction patterns and violence. We conclude this paper by discussing the implications of the model for psychiatric nursing practice.

Violence in psychiatric hospitals: are certain staff prone to being assaulted?

The study reported here investigates (a) whether certain staff in psychiatric hospitals are more prone to being assaulted; (b) whether such proneness can be defined in terms of fixed attributes of these individuals (e.g. sex, personality); and (c) whether staff and patients with certain attributes are regularly combined in violent incidents. The characteristics of 65 nurses and 22 patients involved in 100 consecutive violent incidents were examined. A quarter of hospital staff were assaulted over 3 months but few were assaulted repeatedly. Those who were assaulted more than once were usually assaulted by the same patient, indicating problematic relationships rather than problematic individuals. Only two variables (age and grade) varied significantly between the assaulted and control group staff. It is argued that future research should focus on staff and patient behaviour in violent incidents rather than the characteristics of each.

Violence

This review selects three main areas of recent research into violent behaviour: childhood antecedents of violence; the connection between certain mental disorders and violence; and the related problem of violence in psychiatric hospitals. The complex involvements of many variables is documented and the need for more research to examine the ways these factors interrelate is emphasized.

Managing violence in psychiatric hospitals.

Managing violence in psychiatric hospitals.

Managing violence in psychiatric hospitals.

Managing violence in psychiatric hospitals.

Violence in a psychiatric unit

The aim of this paper is to discuss violence in a modem purpose‐built psychiatric unit, with a view to a better understanding of the associated problems of patient care and their management.The unit was built in 1965 and since then certain changes In its design have been necessary. Some modification of philosophy of care has also been introduced and these changes have benefited the majority of patients, but a plea is made for a ‘small area that is lockable’.The paper makes a valuable contribution to the current discussions into violence in psychiatric hospitals.